Introduction: Implant placement as a means of tooth replacement has increasingly become the gold standard in patient treatment. In cases involving the maxillary posterior site development and implant placement, the clinician must be aware of maxillary sinus anatomy. Lateral wall maxillary sinus augmentation technique was utilized to increase bone height and width for posterior region presented with atrophic ridges. The highest post-operative complication rate for lateral wall sinus augmentation technique is perforation of the maxillary sinus schneiderian membrane. Various risk factors such as smoking, sinusitis, sinus septa, sinus pathology, schneiderian membrane thickness, angle of sinus, etc. may lead to increased prevalence. Purpose: This study aims to evaluate the medial-inferior-lateral (MIL) sinus angle and its resultant relationship with schneiderian membrane perforation in the lateral wall sinus augmentation technique. This study also evaluates the association between schneiderian membrane thickness and perforation risk. Additional confounders including age, gender, ethnicity, and presence of dentition will also be examined.
Materials and Methods: 783 cone beam computed tomography (CBCT) scans taken at the Temple University Kornberg School of Dentistry Department of Oral Maxillofacial Radiology between January 2005 and June 2022 were evaluated with Infinitt Software. Patients above 18 years old, had a pre-operative CBCT scans taken, and had a lateral wall sinus augmentation procedure completed were included in the study. In total, 55 CBCT satisfied the inclusion criteria. The MIL angle formed between the medial, inferior, and lateral walls of the sinus (MIL) were measured. The primary outcome variable is whether or not a perforation occurred during the execution of the lateral wall sinus augmentation procedure. Age, gender, ethnicity, schneiderian membrane thickness and dentition status were evaluated as potential confounders. A chi-squared test and fisher’s exact test were used to determine the association between MIL sinus angle and perforation of the membrane. A multivariable regression analysis was used to test the confounders of age, gender, ethnicity, dentition status, and schneiderian membrane thickness. The validity of the logistic regression model was evaluated by the Wald Test. 95% confidence intervals of perforation rates were calculated with normal approximation under binomial distribution assumption.
Results: This study included 55 subjects subdivided by gender into 15 females and 40 males, and subdivided by ethnicity into 31 Caucasians, 6 African Americans, 15 Asians, and 3 Hispanics. 16 subjects had complete edentulism at the maxillary posterior region and 39 subjects presented with partial edentulism. The overall schneiderian membrane perforation rate was 63.64%. The perforation rate in MIL angles less than 60 degrees was 100%. The perforation rate in MIL angles between 60-90 degrees was 74.19%. The perforation rate in MIL angles greater than 90 degrees was 20.00%. There was a statically significant increase in rate of perforation across the three angle groups with more acute angles showing higher prevalence p < 7.656e-05. The perforation rate in schneiderian membrane thicknesses less than 1.5mm was 75.00% while the rate of perforation in schneiderian membrane thicknesses greater than 1.5mm was 34.78%.
Perforation rate was found statistically significantly higher in female and Hispanic. The risk ratio for female gender was 1.30 95% CI (1.02-1.65) p < 0.01. The risk ratio for Hispanic ethnicity was 1.41 95% CI (1.00-1.99) p < 0.01.
Conclusion: A statistically significant increase in maxillary sinus perforation incidence was found with lower MIL sinus angle. Schneiderian membrane thicknesses greater than 1.5mm had a lower perforation rate than schneiderian membrane thicknesses less than 1.5mm. Female and Hispanic contributed to a statistically higher chance of sinus perforation. Limitations of this study included lateral wall sinus augmentation procedures conducted by Periodontology residents, systemic and social factors were not evaluated, small patient pool, non-homogenous CBCT analysis across various software, lack of documentation regarding the location of perforation, and incongruence amongst studies in calculating metrics such as membrane thickness on CBCT. Future studies are recommended to control for these limitations and should further investigate possible confounders in their results. / Oral Biology
| Identifer | oai:union.ndltd.org:TEMPLE/oai:scholarshare.temple.edu:20.500.12613/8542 |
| Date | January 2023 |
| Creators | Parsons, Timothy MARCUS |
| Contributors | Hsiao, Yueh J., Hsiao, Chinhua, Chialastri, Susan M. |
| Publisher | Temple University. Libraries |
| Source Sets | Temple University |
| Language | English |
| Detected Language | English |
| Type | Thesis/Dissertation, Text |
| Format | 35 pages |
| Rights | IN COPYRIGHT- This Rights Statement can be used for an Item that is in copyright. Using this statement implies that the organization making this Item available has determined that the Item is in copyright and either is the rights-holder, has obtained permission from the rights-holder(s) to make their Work(s) available, or makes the Item available under an exception or limitation to copyright (including Fair Use) that entitles it to make the Item available., http://rightsstatements.org/vocab/InC/1.0/ |
| Relation | http://dx.doi.org/10.34944/dspace/8506, Theses and Dissertations |
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